Asthma mortality and morbidity has been increasing despite advances in understanding the pathophysiology of the disease and considerable advances in both acute treatment and prevention. 'Me greatest impact of this increase has been seen in the inner-city minority patient. 'ne reasons for this are as yet unknown. This project will look at factors that may contribute to the problem. A sample of the pediatric population serviced by the Henry Ford Health System (HFHS) will be the study group. The headquarters and main hospital of HFHS is located in the inner-city of Detroit, Michigan. The mission of HFHS is to serve the people of Detroit and the surrounding metropolitan area, as well as to manage the sixth largest health maintenance organization in the country. Well-defined and accessible case and comparison groups exist within this system. The initial phase (Phase 1) of the project will deal with identification of factors responsible for increased inner-city asthma morbidity/mortality - these include environmental factors and attitudinal issues regarding health care and health care access. Families of asthmatic children will be surveyed through home visits', where dust sampling will take place. The children will contribute a blood sample for specific IgE determination and a urine sample for cotinine measurement, which is an indicator of passive cigarette smoke exposure. A subset of these children will undergo more extensive evaluation of airflow parameters and bronchial hyperreactivity in the allergy clinic in a pilot longitudinal study. The second phase of the study involves intervention -- altering those factors which have been identified in Phase I. This will include close surveillance, environmental control, specialty care access and education of patients and parents regarding asthma. The intended impact of this project will be fewer deaths, hospital admissions, emergency room and outpatient visits, and days of school missed - prevention and control of a chronic reversible disorder.